353 - The Creation of a Pediatric Ambulatory Quality Program and its Impact on the Clinical Environment

Poster Number: 353
Publication Number: 353.345

Jill S. Cioffi, Stony Brook Children's Hospital, quogue, NY, United States; Carolyn Milana, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States

Background: Children’s hospitals have well established quality programs to monitor metrics and quality improvement (QI) projects, however, little has been published on quality programs for academic ambulatory practices.

Objective: Stony Brook Children’s Ambulatory Pediatrics is an academic practice composed of 9 outpatient sites. Our practice sees 26,000 unique patients per year, providing ~48,000 sick visits and ~35,000 well child care visits per annum. In December 2019 we sought to (1) establish an Ambulatory Quality Program (2) clarify and address quality initiatives that had lost their momentum and focus (3) share our initiatives across disciplines and our 9 sites and (4) create a dashboard to follow our progress. Our primary goal was to identify and demonstrate improvement in quality metrics for our primary care practice.

Design/Methods: We identified an interdisciplinary team to sit on our Quality Board. We mirrored our team and process after the Children’s Hospital but tailored it to the ambulatory environment. Education on QI was provided for all team members. A dashboard with primary care measures was created. Monthly meetings were held and adjustments to the structure of the meetings and the dashboard were made. Our data and progress were shared with the primary care division and the department.

Results: Through the formation of the Quality Board, we observed an increased understanding of our long-held quality metrics and were able to introduce new multidisciplinary metrics. Over one year, we observed an improvement in 50% of our 18 metrics across all 9 sites. Most importantly, long term metrics, which had been stagnant, showed sustained improvement. Fill rates for both sick and well child access were also optimized when followed by our Board. Similarly, the goal of well child checkup and immunization status review at the time of sick visits reached and maintained our target goal of 90% since December 2020. Our dashboard also helped during the COVID pandemic when many metrics needed to be closely followed to meet patient needs.Conclusion(s): The creation of an Ambulatory Quality Program was successful at organizing, clarifying and sustaining improvement in our primary care quality metrics and moving along long standing QI measures. It also allowed multidiscipline buy in, increased staff participation and the creation of new quality metrics. Future plans are inclusion of more QI projects as well as subspecialty pediatric care further improving the quality of our ambulatory pediatric care.
Monthly Metrics followed by our Ambulatory Quality BoardImprovement in the number of Monthly Metrics meeting target goals was seen after inception of the Ambulatory Quality Board
Quarterly Metrics followed by our Ambulatory Quality BoardImprovement in the number of Quarterly Metrics meeting target goals was seen after inception of the Ambulatory Quality Board